Respiratory Flashcards
62 male seen in GP with a 40 pack year history of smoking. He has a productive white cough for 4 months. His spirometry reveals FEV1/FVC ratio is 63% predicted value. Echo is normal. What is the likely diagnosis?
A - Pulmonary hypertension B - COPD C - Asthma D - Bronchiolitis obliterans E - Lung cancer
B - COPD.
diagnosis of obstructive confirmed by spirometry, low FEV1/FVC.
66 male seen in ED with a productive green cough. His temperature is 38.3, HR 101, BP 85/58, RR 34. He has WCC 21.1 with a CRP of 188. His other bloods show Na 138, K 4.4, Ur 8.8, Cr 95, eGFR 56. He is orientated to time person and place. What is his CURB-65 score?
A - 0 B - 1 C - 2 D - 3 E - 4
E - 4.
+1 for any:
Confusion Urea <7mmoL RR >30 BP (SBP <90mmHg or DBP <60mmHg) age >65
You see a young 21 female in GP with newly diagnosed asthma. What is your most appropriate first step treatment?
A - Short acting beta 2 agonist inhaler B - Long acting beta 2 agonist inhaler C - Short acting anti-muscarinic inhaler D - Low dose steroid inhaler E - Low dose steroid inhaler + short acting beta 2 agonist inhaler
E - Low dose steroid inhaler + short acting beta 2 agonist inhaler
latest BTS guidelines suggest ICS and short-acting salbutamol, increase dose as treatment plan advances. Then add long-acting beta 2 agonist, etc.
A 44 year old Afro-Caribbean man, with no previous medical history presents with a 4 month history of dry cough and shortness of breath on exertion. Bloods show a raised erythrocyte sedimentation rate (ESR) and raised angiotensin-converting enzyme (ACE). CXR shows bilateral hilar lymphadenopathy. What is the likely diagnosis?
A - Systemic lupus erythematosus (SLE) B - Malaria C - TB D - Sarcoidosis E - Squamous cell carcinoma.
D - Sarcoidosis
CLUES: cause unknown, Afro-Caribbean, inflammation (raised ESR), SOB, bilateral lymphadenopathy.
DEFINITION: disease involving abnormal collections of inflammatory cells forming granulomas. Can effect lungs, skin, lymph nodes, heart. Can cause erythema nodosum.
Tx - conservative, OT, steroids, methotrexate
can cause upper zone pulmonary fibrosis.
A 23 year old man presents to ED with acute SOB. He is known to have Marfan’s syndrome. His CXR shows a pneumothorax measuring 1.5cm in diameter. What is the most appropriate next step after oxygen therapy?
A - Aspiration B - Chest drain with suction C - Underwater chest drain D - Positive pressure (CPAP) E - Salbutamol
A - Aspiration
if <2cm an no SOB consider discharge
if <2cm and SOB, perform aspiration
if fails, insert chest drain
if >2cm, aspirate then chest drain.
not to fly for 2 weeks, never scuba dive, no restriction on driving or contract sports.
You wish to start a patient on salbutamol. They ask you what side effects salbutamol has. Which of the following is not seen with salbutamol?
A - Tremor B - Palpitations C - Bronchospasm D - Hyperkalaemia E - Dizziness
D - Hyperkalaemia
normal range: 3.5 - 5.5.
Tx of hyperkalaemia: calcium gluconate, calcium chloride, nebulised salbutamol, insulin with dextrose.
salbutamol can cause HYPOkalaemia.
Which of the following lung cancers is most associated with exposure to asbestos?
A - Small cell carcinoma B - Sqaumous cell carcinoma C - Large cell carcinoma D - Adenocarcinoma E - Malignant mesothelioma
E - Malignant mesothelioma
squamous associated with smoking, 20% of cancers are small cell (often present late, if detected early surgery can cure, otherwise palliative).
A 53 year old taxi driver from India sees you with a 3 month history of haemoptysis, night sweats and fever. His tests come back positive for TB. He is started on RIPE treatment. [rifampicin, isoniazide, ethambutol, pyrazinamide]. 1 month later he reports his vision is reducing. What is the likely cause?
A - TB spread to optic nerve B - Drug reaction to rifampicin C - Drug reaction to isoniazide D - Drug reaction to ethambutol E - Drug reaction to pyrazinamide
D - Drug reaction to ethambutol.
TB most comply affects the lung, but can also affect CNS (TB meningitis) etc.
Tx: rifampicin, isoniazide, ethambutol, pyrazinamide for 2 months, then rifampicin and isoniazide for 4 more months.
rifampicin SE: orange/red tears secretions.
isoniazide SE: peripheral neuropathy.
pyrazinamide SE: the most hepatotoxic (all are)
ethambutol: optic neuropathy (E for eyes)
A 21 year old girl presents to her GP with a firm, 2cm tender lump lateral to the manubrosternal joint on the right. It has been present for three weeks. It is now becoming more tender, with moderate pleuritic type chest pain. All investigations are normal. What is the likely diagnosis?
A - Asthma B - Lymphoma C - Granulomatosis with polyangiitis D - Sarcoidosis E - Tietze's syndrome
E - Tietze’s syndrome
Costochondritis: inflammation of the sternum. Tietze’s less common, has a physical tender lump.
Most cancers are not tender.
A 28 year old male has been increasingly short of breath for the past 3 weeks. He sweats at night, has a non-productive cough, and has lost 5kg. She has exertional hypoxia (SaO2 86%), is cachectic and has thick white patches on his tongue. On further questioning he tells you he takes heroin recreationally.
A - Bronchial carcinoma B - Lymphoma C - TB D - Pneumocystis jiroveci pneumonia E - Sarcoidosis
D - Pneumocystis jiroveci pneumonia
Points to HIV. People with HIV get oral candidiasis.
exertion hypoxia indicates PJP. Dry cough as sputum very thick. TB would have wet cough. Risk increases when CD4 <200.
Tx: co-trimoxazole, start prophylactically if CD4 <200.
